﻿<%@ Page Title="" Language="C#" MasterPageFile="~/Page.Master" AutoEventWireup="true"
    CodeBehind="CMS_ProfileInfoEdit.aspx.cs" Inherits="_4T.CMS_ProfileInfoEdit" %>

<asp:Content ID="Content1" ContentPlaceHolderID="MainPlaceHolder" runat="server">
    <script type="text/javascript">
        SetCurrentMenu('liWrite')
    </script>
    <script type="text/javascript" src="/jwplayer/jwplayer.js"></script>
    <script type="text/javascript">
        function playvideo(url) {
            jwplayer("video").setup({
                width: 250,
                height: 200,
                file: url
                //width: 200,
                //height: 100
                //image: "/uploads/myPoster.jpg"
            });
        }
    </script>
    <section class="grid_12">
		<div class="block-border"><form class="block-content form add-profile" id="simple_form" method="post" action="" runat="server">
			<h1>Thông tin Hồ sơ</h1>
            
			<fieldset class="grey-bg">
            <legend>Thông tin bệnh nhân</legend>
                <div class="rpContain">
					<div class="rp_left"><label for="complex-title" class="required">Họ tên</label></div>
					<div class="rp_right"><asp:TextBox ID="txtPatientName" runat="server" CssClass="full-width"></asp:TextBox><asp:RequiredFieldValidator ID="RequiredFieldValidator1" runat="server" ErrorMessage="*" ToolTip="Trường bắt buộc" ControlToValidate="txtPatientName"></asp:RequiredFieldValidator></div>
                </div>
                <div class="rpContain">
					<div class="rp_left"><label for="complex-title" class="required">Giới tính</label></div>
					<div class="rp_right">
		                <asp:DropDownList ID="ddlGender" runat="server">
                            <asp:ListItem Value="Male" Text="Nam"></asp:ListItem>
                            <asp:ListItem Value="Female" Text="Nữ"></asp:ListItem>
                        </asp:DropDownList>
                    </div>
                </div>
                <div class="rpContain">
					<div class="rp_left"><label for="complex-title" class="required">Ngày sinh</label></div>
					<div class="rp_right"><asp:TextBox ID="txtDOB" ValidationGroup="AddProfile" runat="server" CssClass="full-width datepicker"></asp:TextBox><asp:RequiredFieldValidator ID="RequiredFieldValidator2" runat="server" ErrorMessage="*" ToolTip="Trường bắt buộc" CssClass="error_text" ControlToValidate="txtDOB" ValidationGroup="AddProfile"></asp:RequiredFieldValidator></div>
                </div>
                <div class="rpContain">
					<div class="rp_left"><label for="complex-title" class="required">CMND</label></div>
					<div class="rp_right"><asp:TextBox ID="txtIDNumber" runat="server" ValidationGroup="AddProfile" CssClass="full-width"></asp:TextBox><asp:RequiredFieldValidator ID="RequiredFieldValidator3" runat="server" ErrorMessage="*" ToolTip="Trường bắt buộc" CssClass="error_text" ControlToValidate="txtIDNumber" ValidationGroup="AddProfile"></asp:RequiredFieldValidator><asp:RegularExpressionValidator ID="RegularExpressionValidator1" ValidationGroup="AddProfile" runat="server" ErrorMessage="*" ToolTip="CMND sai định dạng" ControlToValidate="txtIDNumber" ValidationExpression="[0-9]{9,12}" ></asp:RegularExpressionValidator></div>
                </div>
                <div class="rpContain">
					<div class="rp_left"><label for="complex-title" class="required">Địa chỉ thường trú</label></div>
					<div class="rp_right"><asp:TextBox ID="txtPermAddr" runat="server" ValidationGroup="AddProfile" CssClass="full-width"></asp:TextBox><asp:RequiredFieldValidator ID="RequiredFieldValidator4" runat="server" ErrorMessage="*" ToolTip="Trường bắt buộc" CssClass="error_text" ControlToValidate="txtPermAddr"></asp:RequiredFieldValidator></div>
                </div>
                <div class="rpContain">
					<div class="rp_left"><label for="complex-title">Địa chỉ tạm trú</label></div>
					<div class="rp_right"><asp:TextBox ID="txtTempAddr" runat="server" ValidationGroup="AddProfile" CssClass="full-width"></asp:TextBox></div>
                </div>
                <div class="rpContain">
					<div class="rp_left"><label for="complex-title" class="required">Số điện thoại di động</label></div>
					<div class="rp_right"><asp:TextBox ID="txtMobileNumber" runat="server" ValidationGroup="AddProfile" CssClass="full-width"></asp:TextBox>
                    <asp:RequiredFieldValidator ID="RequiredFieldValidator5" runat="server" ValidationGroup="AddProfile" ErrorMessage="*" ToolTip="Trường bắt buộc" ControlToValidate="txtMobileNumber" CssClass="error_text"></asp:RequiredFieldValidator></div>
                </div>
                <div class="rpContain">
					<div class="rp_left"><label for="complex-title" class="required">Số điện thoại cố định</label></div>
					<div class="rp_right"><asp:TextBox ID="txtPhoneNumber" runat="server" ValidationGroup="AddProfile" CssClass="full-width"></asp:TextBox>
                    <asp:RequiredFieldValidator ID="RequiredFieldValidator6" runat="server" ValidationGroup="AddProfile" ErrorMessage="*" ToolTip="Trường bắt buộc" ControlToValidate="txtPhoneNumber" CssClass="error_text"></asp:RequiredFieldValidator></div>
                </div>
                <div class="rpContain">
					<div class="rp_left"><label for="complex-title" class="required">Người đại diện để liên hệ khẩn cấp</label></div>
					<div class="rp_right"><asp:TextBox ID="txtRepresentativeName" ValidationGroup="AddProfile" runat="server" CssClass="full-width"></asp:TextBox>
                    <asp:RequiredFieldValidator ID="RequiredFieldValidator7" ValidationGroup="AddProfile" runat="server" ErrorMessage="*" ToolTip="Trường bắt buộc" ControlToValidate="txtRepresentativeName" CssClass="error_text"></asp:RequiredFieldValidator></div>
                </div>
                <div class="rpContain">
					<div class="rp_left"><label for="complex-title" class="required">Số điện thoại</label></div>
					<div class="rp_right"><asp:TextBox ID="txtRepresentativePhone" runat="server" ValidationGroup="AddProfile" CssClass="full-width"></asp:TextBox>
                    <asp:RequiredFieldValidator ID="RequiredFieldValidator8" runat="server" ValidationGroup="AddProfile" ErrorMessage="*" ToolTip="Trường bắt buộc" ControlToValidate="txtRepresentativePhone" CssClass="error_text"></asp:RequiredFieldValidator></div>
                </div>
                <div class="rpContain">
					<div class="rp_left"><label for="complex-title">Đầu mối liên hệ ở địa phương. Tên</label></div>
					<div class="rp_right"><asp:TextBox ID="txtLocalContactName" runat="server" CssClass="full-width"></asp:TextBox></div>
                </div>
                <div class="rpContain">
					<div class="rp_left"><label for="complex-title">Số điện thoại</label></div>
					<div class="rp_right"><asp:TextBox ID="txtLocalContactPhone" runat="server" CssClass="full-width"></asp:TextBox></div>
                </div>
                <div class="rpContain">
					<div class="rp_left"><label for="complex-title">Cán bộ y tế</label></div>
					<div class="rp_right"><asp:TextBox ID="txtMedicalStaffName" runat="server" CssClass="full-width"></asp:TextBox></div>
                </div>
                <div class="rpContain">
					<div class="rp_left"><label for="complex-title">Số điện thoại</label></div>
					<div class="rp_right"><asp:TextBox ID="txtMedicalStaffPhone" runat="server" CssClass="full-width"></asp:TextBox></div>
                </div>
                <div class="rpContain">
					<div class="rp_left"><label for="complex-title" class="required">Cơ sở y tế đang điều trị</label></div>
					<div class="rp_right"><asp:TextBox ID="txtMedicalFacility" runat="server" ValidationGroup="AddProfile" CssClass="full-width"></asp:TextBox><asp:RequiredFieldValidator ID="RequiredFieldValidator9" runat="server" CssClass="error_text" ErrorMessage="*" ToolTip="Trường bắt buộc" ValidationGroup="AddProfile" ControlToValidate="txtMedicalFacility"></asp:RequiredFieldValidator></div>
                </div>
                <div class="rpContain">
					<div class="rp_left"><label for="complex-title">Ghi chú khác</label></div>
					<div class="rp_right"><asp:TextBox ID="txtNote" runat="server" CssClass="full-width"></asp:TextBox></div>
                </div>
			</fieldset>
            
            <fieldset class="grey-bg">
            <legend>Thông tin bệnh án</legend>
                <div class="rpContain">
					<div class="rp_left"><label for="complex-title" class="required">Chuẩn đoán</label></div>
					<div class="rp_right"><asp:TextBox ValidationGroup="AddProfile" ID="txtDiagnosis" runat="server" TextMode="MultiLine" CssClass="full-width"></asp:TextBox><asp:RequiredFieldValidator ID="RequiredFieldValidator10" runat="server" CssClass="error_text" ErrorMessage="*" ToolTip="Trường bắt buộc" ValidationGroup="AddProfile" ControlToValidate="txtDiagnosis"></asp:RequiredFieldValidator></div>
                </div>
                <div class="rpContain">
					<div class="rp_left"><label for="complex-title" class="required">Thời gian mắc bệnh</label></div>
					<div class="rp_right"><asp:TextBox ValidationGroup="AddProfile" ID="txtMedicalTime" runat="server" CssClass="full-width datepicker"></asp:TextBox></div>
                </div>
                <div class="rpContain">
					<div class="rp_left"><label for="complex-title" class="required">Phương pháp cần chữa trị</label></div>
					<div class="rp_right"><asp:TextBox ValidationGroup="AddProfile" ID="txtTreatmentMethod" runat="server" TextMode="MultiLine" CssClass="full-width"></asp:TextBox><asp:RequiredFieldValidator ID="RequiredFieldValidator11" runat="server" ErrorMessage="*" CssClass="error_text" ToolTip="Trường bắt buộc" ValidationGroup="AddProfile" ControlToValidate="txtTreatmentMethod"></asp:RequiredFieldValidator></div>
                </div>
                <div class="rpContain">
					<div class="rp_left"><label for="complex-title" class="required">Hoàn cảnh, khó khăn hiện đang gặp</label></div>
					<div class="rp_right"><asp:TextBox ValidationGroup="AddProfile" ID="txtSituation" runat="server" TextMode="MultiLine" CssClass="full-width"></asp:TextBox><asp:RequiredFieldValidator ID="RequiredFieldValidator12" runat="server" ErrorMessage="*" CssClass="error_text" ToolTip="Trường bắt buộc" ValidationGroup="AddProfile" ControlToValidate="txtSituation"></asp:RequiredFieldValidator></div>
                </div>
                <div class="rpContain">
					<div class="rp_left"><label for="complex-title" class="required">Cần hỗ trợ giúp đỡ</label></div>
					<div class="rp_right"><asp:TextBox ValidationGroup="AddProfile" ID="txtSupport" runat="server" TextMode="MultiLine" CssClass="full-width"></asp:TextBox><asp:RequiredFieldValidator ID="RequiredFieldValidator13" runat="server" ErrorMessage="*" CssClass="error_text" ToolTip="Trường bắt buộc" ValidationGroup="AddProfile" ControlToValidate="txtSupport"></asp:RequiredFieldValidator></div>
                </div>
			</fieldset>
            <fieldset class="grey-bg">
            <legend>Thông tin người cung cấp</legend>
                <div class="rpContain">
					<div class="rp_left"><label for="complex-title" class="required">Họ tên</label></div>
					<div class="rp_right"><asp:TextBox ValidationGroup="AddProfile" ID="txtInfoSupplierName" runat="server" CssClass="full-width"></asp:TextBox><asp:RequiredFieldValidator ID="RequiredFieldValidator14" runat="server" ErrorMessage="*" ToolTip="Trường bắt buộc" CssClass="error_text" ValidationGroup="AddProfile" ControlToValidate="txtInfoSupplierName"></asp:RequiredFieldValidator></div>
                </div>
                <div class="rpContain">
					<div class="rp_left"><label for="complex-title" class="required">Số điện thoại</label></div>
					<div class="rp_right"><asp:TextBox ValidationGroup="AddProfile" ID="txtInfoSupplierPhone" runat="server" CssClass="full-width"></asp:TextBox><asp:RequiredFieldValidator ID="RequiredFieldValidator15" runat="server" ErrorMessage="*" ToolTip="Trường bắt buộc" CssClass="error_text" ValidationGroup="AddProfile" ControlToValidate="txtInfoSupplierPhone"></asp:RequiredFieldValidator></div>
                </div>
                <%--<div class="rpContain">
					<div class="rp_left"><label for="complex-title" class="required">Mã số</label></div>
					<div class="rp_right"><asp:TextBox ValidationGroup="AddProfile" ID="txtPersonalCode" runat="server" CssClass="full-width"></asp:TextBox><asp:RequiredFieldValidator ID="RequiredFieldValidator16" runat="server" ErrorMessage="*" ToolTip="Trường bắt buộc" ValidationGroup="AddProfile" ControlToValidate="txtPersonalCode"></asp:RequiredFieldValidator></div>
                </div>--%>
                <div class="rpContain">
					<div class="rp_left"><label for="complex-title">Email</label></div>
					<div class="rp_right"><asp:TextBox ValidationGroup="AddProfile" ID="txtEmail" runat="server" CssClass="full-width"></asp:TextBox></div>
                </div>
			</fieldset>
            <fieldset class="grey-bg">
            <legend>Hình ảnh, video đính kèm</legend>
                    <div class="rpContain">
				        <div class="rp_left"><label for="complex-title">Hình ảnh:</label></div>
				        <div class="rp_right"><asp:Literal ID="ltrImage" runat="server"></asp:Literal>                            
                        </div>
                    </div>
                    <div class="rpContain">
				        <div class="rp_left"><label for="complex-title">Video:</label></div>
				        <div class="rp_right"><div id="video"></div></div>
                    </div>
                </fieldset>
            <fieldset class="grey-bg">
            <legend>Thông tin khác</legend>
                <div class="rpContain">
				        <div class="rp_left"><label for="complex-title">Mô tả ngắn:</label></div>
				        <div class="rp_right">
                            <asp:TextBox ValidationGroup="AddProfile" ID="txtDescription" runat="server" CssClass="full-width" TextMode="MultiLine"></asp:TextBox>
                        </div>
                    </div>
                    <div class="rpContain">
				        <div class="rp_left"><label for="complex-title">Thời gian đề xuất:</label></div>
				        <div class="rp_right"><asp:TextBox ValidationGroup="AddProfile" ID="txtProposeDate" runat="server" CssClass="full-width datepicker"></asp:TextBox>                          
                        </div>
                    </div>
                </fieldset>

			<fieldset class="grey-bg no-margin">
            <asp:HiddenField runat="server" ID="hdfProfileCode" />
				<%--<legend>Action on create</legend>--%>
				<p class="input-with-button">
					<%--<label for="simple-action">Select action</label>
					<select name="simple-action" id="simple-action">
						<option value="1">Save and publish</option>
						<option value="2">Save only</option>
					</select>--%>
                    <asp:Button ID="btnSave" runat="server" ValidationGroup="AddProfile" CausesValidation="true" Text="Lưu" CssClass="big-button" onclick="btnSave_Click" />
					<%--<button type="button">Create</button>--%>
				</p>
			</fieldset>
					
		</form></div>
</section>
</asp:Content>
